The Bangladeshi NGO known as Friendship may be best known for its floating hospitals which serve the isolated people who live on the ‘chars’, the remote and moving islands that form and dissolve in the country’s three mighty rivers. It understands that solutions and programs for the char dwellers must be as multi-faceted and interlinked as their problems.
Economic welfare only works for a community that has health care and education. Successful health care needs a sanitation infrastructure. Students can’t be educated if they are hungry. And improvements can’t be sustained if peoples’ work is regularly wiped out by natural disasters. So Friendship’s model interlinks six programs – health, education, sustainable economic development, disaster management and infrastructure development, good governance, and cultural preservation.
Some observers think it is one of the most successful social enterprises in the world. Others point to it as a brilliant example of what can happen when NGOs in the Global South organize to meet their own problems, rather than importing solutions from the Global North.
While Runa Khan is well known for her work these days, the NGOs she approached in the late 1990s about helping her turn an old French barge into a floating hospital thought it was too ambitious and wouldn’t work. French sailor and aviator Yves Marre had sailed the barge from France to Bangladesh in 1994 to donate it to the Bangladeshi people. Runa and Yves decided to found their own NGO, and also became life partners.
Now Friendship has 4,300 employees, is headquartered in Bangladesh, and has a network of five Friendship organizations in European countries. And what started as a project that nobody believed would work, has now become a model for the government to provide healthcare to hard-to-reach communities.
Unilever, which makes the popular Lifebuoy soap, sponsored the first floating hospital – Lifebuoy Friendship Hospital – which launched in 2002 and was renovated in 2012. The Canadian International Development Agency also provided support. Over two decades, it has provided medical care to over 657,000 people in remote char areas of Bangladesh and organized 416 specialized health camps for marginalized riverine communities where 16,385 successful life-changing surgeries were done.
The Emirates Friendship Hospital, inaugurated in 2008, is financed by the Emirates Airline Foundation and serves over three million people living on more than 400 small islands and on the river banks along the River Brahmaputra. The Emirates Airline Foundation uses donated points to provide free travel for volunteer doctors from all over the world, for both ships, which together treat on average a hundred thousand patients every year in the northern river areas of Bangladesh.
A third ship, Rongdhonu – formerly the Rainbow Warrior II donated by Greenpeace International – operated in the south between 2013 and 2018, treating more than 163,000 patients on board and performing more than 8,500 surgical interventions.
The hospital ship was only a starting point. A three-tier system evolved that let Friendship take health care to 615 villages. It began sending out teams of nurses and medics to villages to create ‘satellite clinics’, and started training local women from the chars as Friendship Community Medic-aides on call to give immediate assistance and call for ambulances if needed.
The floating hospital fleet is set to expand with five Saudi-funded floating hospitals. Two of them are ready to sail, pending registration with the Bangladeshi authorities soon after Ramadan, the Arab News reported in March 2023. Each ship will anchor in a fixed location for two-and-a-half months with patients being referred from mobile clinics, Khan said.
Under a 2017 agreement with the Bangladeshi Directorate General of Health Services, the five ships will be operated by Friendship for five years before being handed over to the health authorities. The $20 million cost of building the ships and the first five years of operation is funded by the Islamic Development Bank under the King Abdullah bin Abdulaziz Programme for Charity Works.
The biggest ship, King Abdullah Hospital 1, is 31 meters long, and has an operating theater for general surgery and separate theater for eye surgery. The other four ships will provide primary health care and minor operative procedures. Khan estimates that each ship will treat up to 350,000 people every month.
The entire integrated model of Friendship’s operations is spelled out in an article in Humanitarian Alternatives. Summarizing:
More than 5,000 children attend Friendship primary schools and achieve well above average results in national exams. In 2015, Friendship started secondary education in 5 “chars” as a pilot model, using pre-recorded lessons by teachers of good private schools, solar panels and computers. As well, 1,500 adolescents and adults attend Functional Literacy classes in Friendship’s 74 schools and education centres.
Friendship’s Disaster Management and Infrastructural Development program trains about 5.000 direct beneficiaries a year on Community Managed Disaster Risk Reduction. Six desalination plants have been established in salinity prone areas which can provide access to fresh drinking water to 80.000 people.
An innovative system enables ultra-poor access finance, and its Sustainable Economic Development program aids 5,700 poor farmers and fishermen. More than 1.000 Solar Home Systems have been installed (on a leasing basis) in very poor households. Vocational training centres for weaving, dyeing and tailoring train over 130 women per year while currently 140 women are directly employed in those centres.
The Good Governance program makes people aware of their rights as citizens and offers them access to justice and legal services through Friendship Civil Society Groups in 35 islands.
“Our programmes interconnect with each other to support an integrated approach to development,” says Marc Elvinger, who co-chairs Friendship International. “Once the “step-by-step” approach was developed, it allowed the organization to develop positive synergies in its day-to-day journey, and most importantly helped to adapt its programs to identified needs.”
New models of working and partnership in development: the example of Friendship, a Bangladeshi organisation. Runa Khan, Humanitarian Alternatives.
Saudi-funded floating hospitals to bring healthcare to rural Bangladesh. Arab News, Mar. 14, 2023
Turning the tide. Dhaka Tribune, Sep. 13, 2018
Lifebuoy Friendship Hospital treats over 6 lakh people in 20 years. New Age, Feb.28, 2023
Friendship Floating Hospitals: Healthcare for the Riverine People of Bangladesh. Journal of Developing Societies, March 2019
Cover image: Afifa Afrin, Wikimedia